Efficiency of a virtual fracture care review protocol for semi-elective surgical treatment in trauma patients

Abstract text (incl. references and figure legends)

Introduction

Virtual Fracture Clinics (VFC) have been widely accepted in management of trauma patients.1 This study aimed to determine the effect of VFC on efficiency of follow-up treatment in trauma patients who underwent semi-elective surgical treatment.

Materials & Methods

In this retrospective cohort study, patients who received semi-elective surgery due to traumatic injury in 2019 and 2021 were included. All patients were treated at an urban level 2 trauma center, where VFC protocols were implemented during 2020. Of two study groups, one consisted of patients treated traditionally (pre-VFC group), one of patients treated through VFC review (VFC group). Outcomes included secondary healthcare utilization, time from emergency department (ED) presentation to surgery, and complications.

Results

In total, 1153 pre-VFC and 1102 VFC patients were included. The median number of outpatient clinic consultations was 5 (IQR:3) in pre-VFC patients and 4 (IQR:4) in VFC patients (p<0.01). Pre-VFC patients had a median of 5 (IQR:4) face-to-face consultations and 0 (IQR:0) by phone. For VFC patients, this was 3 (IQR:3) and 1 (IQR:1), respectively (p<0.01). A median of 2 (IQR:1) follow-up X-rays were acquired in pre-VFC patients vs. 1 (IQR:1) in VFC patients (p<0.01). Less follow-up CT-scans were made in VFC patients, with a median of 0 (IQR:0) vs. 0 (IQR:0), respectively (p=0.01). Time from ED presentation to surgery was shorter in the VFC group, with a median of 8 (IQR:6) days vs. 8 (IQR:5) in the pre-VFC group (p=0.01). Complication rates were similar, with 3.9% pre-VFC and 3.1% in VFC patients (p=0.49).

Conclusions

VFC review reduced secondary healthcare utilization, increased remote delivery of care, and reduced time from ED presentation to surgery. Complication rates were low and similar between groups.

References

Davey MS et al. Virtual Fracture Clinics in Orthopaedic Surgery - A Systematic Review of Current Evidence. Injury. 2020;51(12):2757-2762

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